The Study Of CT-Guided Medical Adhesive Localization Of Pulmonary Nodules Before VATS And Comparative Analysis Of Imaging And Pathology

ObjectiveTo investigate the clinical value of CT-guided localization of pulmonary nodules with medical adhesive before video-assisted thoracoscopic surgery(VATS)and to evaluate the differential diagnostic value of CT in different subtypes of subsolid lung adenocarcinoma.MethodsA total of 166 patients with 174 pulmonary nodules were retrospectively analyzed in Hainan Hospital of PLA General Hospital from August 2016 to October 2022,all of which received CT-guided medical adhesive localization before VATS.The localization efficacy and intraoperative complications were recorded.The influence of patients’ general data,nodule type,maximum diameter,nodule location,patient position,nodule distance from the pleura,the depth of the puncture needle and localization time on the occurrence of complications related to localization were analyzed,and those statistically different data were screened for binary logistic regression analysis to obtain the independent risk factors of related complications.According to the postoperative pathologic results,the nodules diagnosed as subsolid lung adenocarcinoma were divided into 3 groups,including preinvasive lesions(PL,n=31),minimally invasive adenocarcinomas(MIA,n=12)and invasive adenocarcinomas(IA,n=26).The differences of clinical data and CT imaging data were compared among the three groups,and the multivariate ordinal logistic regression analysis was used to obtain the independent risk factors for invasiveness of subsolid lung adenocarcinoma.These subsolid lung adenocarcinomas were further divided into IA group(n=26)and non-IA(PL+MIA)group(n=103).The differences of CT quantitative parameters were compared between the two groups,and the binary ordinal logistic regression was used to obtain the combined prediction index.The receiver operating characteristic(ROC)curves were drawn to evaluate the diagnostic efficacy of each parameter alone and the combined index in predicting IA.Results1、The effect of CT-guided localization of pulmonary nodules with medical adhesive before VATS:A total of 174 nodules underwent CT-guided localization of medical adhesive before VATS with the localization success rate of 98.28%(171/174),including 158 cases of single-nodule localization and 8 cases of double-nodule localization.During the localization process,47 cases(47/158,29.75%)had slight intrapulmonary hemorrhage,36 cases(36/158,22.78%)developed slight pneumothorax,28 cases(28/158,17.72%)had a small amount of subcutaneous emphysema,and irritant cough occurred in 2 cases(2/158,1.27%).The univariate analysis showed that the depth of puncture needle and localization time were the related influencing factors affecting the occurrence of intrapulmonary hemorrhage(P<0.05),while the age,nodule maximum diameter and patient position were the related influencing factors affecting the occurrence of pneumothorax(P<0.05),and the gender and localization time were the related influencing factors affecting the occurrence of subcutaneous emphysema(P<0.05).The binary logistic regression showed that the depth of puncture needle was the independent risk factor for intrapulmonary hemorrhage,the age and patient position were the independent risk factors for pneumothorax,and the gender and localization time were the independent risk factors for subcutaneous emphysema.2.Study on comparative analysis of CT imaging and pathology of subsolid lung adenocarcinomas:The age,nodule type,edge,shape,vascular clustering sign,vacuole sign,maximum diameter,mean diameter,3D long diameter,mean CT value,volume,quality,maximum slice area and surface area had statistical differences in PL,MIA and IA groups(P<0.05).And the pleural indentation sign had no statistical difference in the three groups of subpleural nodules(P=0.079).The multivariate ordinal logistic regression analysis showed that the age,mean CT value and vacuole sign were the independent risk factors to evaluate the invasive degree of lung adenocarcinoma(P<0.05).The CT quantitative parameters(maximum diameter,mean diameter,3D long diameter,mean CT value,volume,quality,maximum slice area,surface area)had statistical differences between the IA group and non-lA group(P<0.05).The area under curve(AUC)of the 8 CT quantitative parameters alone and combined index diagnosing IA was respectively 0.796,0.768,0.772,0.687,0.742,0.787,0.758,0.743,0.855(P<0.05).Conclusion1.CT-guided medical adhesive localization of pulmonary nodules before VATS is safe and effective with minor complications.2.CT could be used to differentiate subtypes of subsolid lung adenocarcinomas.